From the Guidelines
To make Half Dextrose RL, mix equal parts of 5% Dextrose in Water (D5W) and Ringer's Lactate (RL) solutions, resulting in a solution containing 2.5% dextrose. This can be accomplished by combining 500 mL of D5W with 500 mL of RL to create 1 liter of Half D/RL, as guided by the composition of commonly used fluids, including Ringer's Lactate and 5% glucose, as outlined in the NICE Guideline (CG174) 1. The resulting Half D/RL solution provides both glucose for energy and essential electrolytes (sodium, potassium, calcium, and chloride) for fluid and electrolyte replacement, which is crucial for maintaining proper fluid balance and providing caloric support in various clinical situations, such as postoperative care or mild dehydration, as inferred from the electrolyte composition comparison in the study 1. Key considerations include:
- Verifying the compatibility of any medications that might be added to this solution
- Following institutional protocols for preparation
- Understanding the nutritional and electrolyte content, such as the approximately 85 calories per liter provided by the dextrose component
- Recognizing the importance of electrolyte balance, as indicated by the sodium, chloride, potassium, and calcium levels in the solution, which are critical for patient outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
For central venous administration: For total parenteral nutrition 50% Dextrose Injection, USP is administered by slow intravenous infusion (a) after admixture with amino acid solutions via an indwelling catheter with the tip positioned in a large central vein, preferably the superior vena cava, or (b) after dilution with sterile water for injection The FDA drug label does not answer the question.
From the Research
Preparation of Half Dextrose RL
To prepare Half Dextrose RL, the following components are required:
- 5% Dextrose solution
- Lactated Ringer's (LR) solution
Steps to Prepare Half Dextrose RL
- Mix 50% of 5% Dextrose solution with 50% of Lactated Ringer's solution to create Half Dextrose RL.
- The resulting solution will have a dextrose concentration of 2.5% and the electrolyte composition of half-strength Lactated Ringer's solution.
Considerations
- The compatibility of 5% dextrose solution with Lactated Ringer's solution should be considered, as some studies have shown that mixing certain intravenous solutions can cause hemolysis, agglutination, and clotting 2.
- The use of Half Dextrose RL as an intravenous fluid replacement should be based on the patient's individual needs and medical condition, as some studies have shown that dextrose-containing solutions can cause hyperglycemia 3.
- Lactated Ringer's solution has been shown to be a suitable alternative to normal saline for fluid resuscitation in certain medical conditions, such as diabetic ketoacidosis 4, 5.
- The effect of rapid infusion of Half Dextrose RL on blood electrolyte concentrations, plasma osmolality, and brain edema should be considered, as some studies have shown that rapid infusion of certain intravenous solutions can have deleterious effects 6.